Impact of coping styles on substance use in persons with psychosis, siblings, and controls

Association between psychosis and substance use in Kenya. Findings from the NeuroGAP-Psychosis study

Background

Substance use is prevalent among people with mental health issues, and patients with psychosis are more likely to use and misuse substances than the general population. Despite extensive research on substance abuse among the general public in Kenya, there is a scarcity of data comparing substance use among people with and without psychosis. This study investigates the association between psychosis and various substances in Kenya.

Methods

This study utilized data from the Neuro-GAP Psychosis Case-Control Study between April 2018 and December 2022. The KEMRI-Wellcome Trust Research Programme recruited participants from various sites in Kenya, including Kilifi County, Malindi Sub-County, Port Reitz and Coast General Provincial Hospitals, and Moi Teaching and Referral Hospital, as well as affiliated sites in Webuye, Kapenguria, Kitale, Kapsabet, and Iten Kakamega. The collected data included sociodemographic information, substance use, and clinical diagnosis. We used the summary measures of frequency (percentages) and median (interquartile range) to describe the categorical and continuous data, respectively. We examined the association between categorical variables related to psychosis using the chi-square test. Logistic regression models were used to assess the factors associated with the odds of substance use, considering all relevant sociodemographic variables.

Results

We assessed a total of 4,415 cases and 3,940 controls. Except for alcohol consumption (p-value=0.41), all forms of substance use showed statistically significant differences between the case and control groups. Cases had 16% higher odds of using any substance than controls (aOR: 1.16, 95%CI: 1.05-1.28, p=0.005). Moreover, males were 3.95 times more likely to use any substance than females (aOR:3.95; 95%CI: 3.43-4.56). All the categories of living arrangements were protective against substance use.

Conclusion

The findings of this study suggest that psychotic illnesses are associated with an increased likelihood of using various substances. These findings are consistent with those of previous studies; however, it is crucial to investigate further the potential for reverse causality between psychosis and substance abuse using genetically informed methods.

The association between childhood trauma and tobacco smoking in patients with psychosis, unaffected siblings, and healthy controls

In patients with psychosis, rates of tobacco smoking and childhood trauma are significantly higher compared to the general population. Childhood trauma has been proposed as a risk factor for tobacco smoking. However, little is known about the relationship between childhood trauma and smoking in psychosis. In a subsample of the Genetic Risk and Outcome of Psychosis study (760 patients with psychosis, 991 unaffected siblings, and 491 healthy controls), tobacco smoking was assessed using the Composite International Diagnostic Interview and childhood trauma was measured with the Childhood Trauma Questionnaire. Logistic regression models were used to assess associations between trauma and smoking, while correcting for confounders. Positive associations were found between total trauma, abuse, and neglect, and an increased risk for smoking in patients, while correcting for age and gender (ORtrauma 1.77, 95% CI 1.30-2.42, p < 0.001; ORabuse 1.69, 95% CI 1.23-2.31, p = 0.001; ORneglect 1.48, 95% CI 1.08-2.02, p = 0.014). In controls, total trauma and abuse were positively associated with smoking, while correcting for age and gender (ORtrauma 2.40, 95% CI 1.49-3.88, p < 0.001; ORabuse 2.02, 96% CI 1.23-3.32, p = 0.006). All associations lost their significance after controlling for additional covariates and multiple testing. Findings suggest that the association between childhood trauma and tobacco smoking can be mainly explained by confounders (gender, cannabis use, and education) in patients with psychosis. These identified aspects should be acknowledged in tobacco cessation programs.

[Staying Healthy While Caregiving at Home? Risk and Protective Factors for Dysfunctional Coping in Family Caregivers]

OBJECTIVE

In Germany, 3.3 million people in need of care are cared for at home. More than half (54%) of informal caregivers estimate their own stress as high or very high [1]. Coping strategies, including dysfunctional ones, are used to cope with stress. These bear the risk of negative health consequences. The aim of this study is to assess the frequency of dysfunctional coping strategies among informal caregivers and to identify protective and risk factors for these unfavorable coping mechanisms.

METHODS

A cross-sectional study with N=961 interviewed informal caregivers in Bavaria was conducted in 2020. Dysfunctional coping strategies (substance use and abandonment/avoidance) were assessed. Additionally, subjective stress, positive aspects of caregiving, caregiving motives, characteristics of the caregiving situation as well as caregivers' cognitive evaluation of the care situation and their subjective assessment of available resources (based on the Transactional Stress Model) were recorded. Descriptive statistics were used to explore the frequency of dysfunctional coping behavior. Linear regressions were run, after statistical precondition testing, to investigate which predictors can be identified for dysfunctional coping.

RESULTS

14.7% of respondents reported using alcohol or other substances at least some of the time in difficult situations, and 47.4% of respondents had given up dealing with the care situation. Subjective caregiver burden (p<0.001), the motive to care out of obligation (p=0.035), and resources for manageability of the caregiving situation rated as insufficient (p=0.029) were identified as risk factors for dysfunctional coping in a significant overall model with medium fit (F (10)=16.776; p<0.001).

DISCUSSION AND CONCLUSION

Dysfunctional coping concerning the stress related to the caregiving situation is not uncommon. The most promising target for intervention is subjective caregiver burden. This is known to be reduced by the use of formal and informal help [2, 3]. However, this requires overcoming the problem of low rates of use of counseling and other support services [4]. Newer digital promising approaches to this are being developed [5, 6].

Association of psychological distress with smoking cessation, duration of abstinence from smoking, and use of non-combustible nicotine-containing products: A cross-sectional population survey in Great Britain

BACKGROUND

Tobacco smoking cessation is associated with improvements in mental health. This study assessed psychological distress, using the K6 non-specific screening tool ((items cover feelings of nervousness, hopelessness, restlessness, depression, 'everything an effort' and worthlessness), by smoking status, time since quit, and use of a non-combustible nicotine product.

METHODS

Monthly repeat cross-sectional household survey of adults (18 + ) from October 2020-February 2022 in Great Britain (N = 32,727). Using unadjusted and adjusted logistic regression (adjusted models included socio-demographic characteristics and ever diagnosis with a mental health condition), we assessed: associations between any/serious past-month psychological distress and smoking status and time since quit, whether these relationships were moderated by ever diagnosis with a mental health condition, and associations between distress and use of a nicotine product by people who formerly smoked.

RESULTS

In the unadjusted model, those who had not smoked for > 1y and who had never smoked had lower odds of any distress (OR = 0·42, 95 % CI 0·39-0·45; OR = 0·44, 0·41-0·47) compared with those who currently smoked. Moreover, the association of lower distress in those who had not smoked for > 1y and never smoked compared with those who currently smoked was more pronounced among those who had ever been diagnosed with a mental health condition (AOR = 0·58, 0·51-0·66; AOR = 0·60, 0·53-0·67) than among those who had not (AOR = 0·86, 0·76-0·98; AOR = 0·72, 0·65-0·81). In adjusted models of people who formerly smoked, current use of any nicotine product was associated with higher odds of distress compared with not using any nicotine product (AOR 1·23, 1·06-1·42).

CONCLUSION

People who had never smoked, or had not smoked for > 1y had lower levels of distress than those who currently smoked. The lower odds of distress among people who had not smoked for > 1y was more pronounced among those with an ever (vs never) diagnosis of a mental health condition. Nicotine product use among those who formerly smoked was associated with greater distress. Due to potential residual confounding and selection bias more research is needed to determine causality.